运动性横纹肌溶解症37例诊治分析

Diagnosis and treatment of 37 cases of athletic rhabdomyolysis

目的探讨运动性横纹肌溶解症的临床诊治方法,提升治疗效果。方法回顾性分析武警湖北省总队医院和华中科技大学同济医院2007年10月至2018年11月收治的37例运动性横纹肌溶解症患者的临床资料。37例患者予以抗感染、补充血容量、止吐、退热、碱化尿液等对症治疗。8例急性肾功能不全患者,血肌酐>442μmol/L或者血钾>6.5 mmol/L,采用血液透析治疗。结果患者平均住院时间9(4~25)d。37例患者出院时血清肌酸激酶值均降至正常范围或轻度异常升高。8例急性肾功能不全患者经血液透析治疗后,复查肾功能、电解质均恢复正常。结论运动性横纹肌溶解症首发症状多样,容易误诊、漏诊。早期检查血清肌酸激酶、肌红蛋白有利于及早确定诊断。抗感染治疗、对症治疗、补充血容量、碱化尿液、血液透析等综合治疗有利于患者预后。对运动性横纹肌溶解症所致重度急性肾功能不全患者,行血液透析治疗能有效挽救肾功能,降低患者病死率。

Objective To explore the clinical diagnosis and treatment of exertional rhabdomyolysis to improve its therapeutic effects.Methods The clinical data of 37 cases of exertional rhabdomyolysis were retrospective analyzed.All cases were given symptomatic treatments such as anti-infection,blood volume supplementation,antiemetic and antipyretic treatments,and alkalization of urine.Six patients with severe acute renal insufficiency,serum creatinine over 442μmol/L,or hyperkalemia were treated by hemodialysis.Results The average hospitalization time was 9(range,4-25)days.Serum creatine phosphokinase decreased to normal in 37 patients at discharge.After hemodialysis,renal function and electrolytes returned to normal in the six patients with severe acute renal insufficiency.Conclusion The initial symptoms of exertional rhabdomyolysis are various and easy to be misdiagnosed or missed.Early detection of serum creatine phosphokinase and myoglobin is helpful for early diagnosis.Symptomatic treatments,such as blood volume supplementation,alkalization of urine,and hemodialysis,are beneficial to the prognosis of patients.Early hemodialysis can effectively improve renal function and reduce mortality in patients with severe acute renal insufficiency caused by exertional rhabdomyolysis.